Failure to Provide Toenail and Podiatry Care for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate foot care and arrange podiatry services for a cognitively intact resident with atrial fibrillation and heart failure who required moderate assistance with ADLs and was dependent for bathing. On admission and in subsequent weekly nursing assessments from late January through mid-March, there was no documentation of issues with the resident’s toenails, despite observations on March 16 that both feet had long, jagged toenails and the right great toenail had brownish discoloration extending from the base toward the middle of the nail. The resident reported having asked several times for toenail trimming, stated he had never refused toenail care, and said he had been told he would see a podiatrist but believed no appointment had been made. The EMR contained no documentation that toenail or podiatry care was offered or refused, although it did show refusals of showers and UNNA boot care. Staff interviews confirmed awareness of the toenail condition but revealed no follow-through. A NA who frequently cared for the resident stated he had noticed the toenails were very long and needed trimming but did not recall reporting this to a nurse and had not asked the resident about toenail trimming. A nurse reported the resident had been admitted with long, discolored toenails, especially the right great toe, but acknowledged he did not document this, notify the provider, or attempt to trim the nails, and he had not informed social work of the need for podiatry. The podiatry clinic schedules for February and March did not list the resident, and there were no podiatry consult notes or visit documentation in the EMR since admission. The Social Work Director stated he was unaware of any podiatry needs for this resident until a nurse requested adding the resident to the podiatry list on the day of the interview. The DON stated she was aware of the toenail issue and believed the resident refused care frequently, including toenail care, but there was no documentation of such refusals in the EMR.
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